In het alledaagse taalgebruik zijn psychiatrische diagnoses uniforme categorieën geworden: iemand heeft ADHD en behoort daarmee tot de homogeen voorgestelde groep ‘ADHD’ers’. Categorische psychiatrische diagnostiek is weliswaar een noodzakelijkheid om met elkaar van gedachten te kunnen wisselen over de problematiek maar suggereert ook een uniformiteit waarachter aanzienlijke interindividuele verschillen schuil kunnen gaan. Juist die heterogeniteit maakt het moeilijk gericht onderzoek te doen naar de neurobiologische oorzaken van verschillende stoornissen. Dit artikel behandelt hoe theorievorming over en empirisch onderzoek naar heterogeniteit in de neurobiologie van aandachtstekortstoornis met hyperactiviteit (Attention-Deficit/Hyperactivity Disorder,of ADHD) ons dichter bij de oorzaken ervan zou kunnen brengen. Hiervoor worden studies gebruikt uit het proefschrift van de auteur en werk van andere onderzoeksgroepen. Het betreft vooral studies bij kinderen en adolescenten met ADHD maar de bespreking kan zeker geëxtrapoleerd worden naar ADHD bij volwassenen.
Abstract
Background.The dichotomous diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) suggests a homogeneous clinical and etiological entity. In reality, much variation between patients is commonly found, both clinically as well as in neurobiological and neuropsychological studies.Method. This article discusses how neurobiological and neuropsychological heterogeneity may be a specific target of research. Both research into brain development and neuropsychology in ADHD is addressed.Results. First, an example is given of how results of genetic studies on the ADHD-IQ relationship can lead to hypotheses on differential brain development in ADHD in low versus high IQ. Next, neuropsychological heterogeneity is addressed. Separate brain systems are involved in separable aspects of cognition that may be affected in ADHD. Based on the large body of neuropsychological work to date, multiple authors have suggested that not all brain systems implicated in ADHD (and the cognitive functions they support) should necessarily be affected in all patients with the disorder. A number of studies investigating such neuropsychological heterogeneity are discussed. Finally, etiological heterogeneity is briefly addressed: several causative factors may affect changes in brain and cognition in ADHD in concert or in interaction.Conclusions. Inconsistencies in the neurobiological literature on ADHD may arise in part because the heterogeneity that can be expected in the underlying neurobiology is not acknowledged. For example, by studying more neurobiologically homogeneous subgroups, research may be better able to target separable developmental pathways towards ADHD.
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De auteur bedankt drs. M. Nelwan voor het kritisch lezen van een eerdere versie van het manuscript.
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de Zeeuw, P. Neurobiologische en neuropsychologische heterogeniteit bij ADHD. NEUROPRAXIS 16, 79–86 (2012). https://doi.org/10.1007/s12474-012-0014-4
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DOI: https://doi.org/10.1007/s12474-012-0014-4